Author of

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  P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.12-001 - Efficacy of pulmonary resection and gamma knife surgery for non-small cell lung cancer with synchronous brain metastasis (ID 155)

    09:30 - 09:30  |  Author(s): T. So
    • Abstract

    Background
    Several studies suggest that pulmonary resection and gamma knife surgery (GKS) protocol prolong survival in patients with thoracic stage I or II non-small cell lung cancer (NSCLC), without extra-cranial or lymph node metastases, and with a limited number of small synchronous brain metastases. According to the Japanese Lung Cancer Society guidelines published in 2012, stereotactic radiosurgery (SRS) or surgery for a single brain metastatic lesion and SRS or stereotactic radiotherapy (SRT) for 2-4 brain metastatic lesions, less than 3 cm in length, are Grade B recommendations. To validate these recommendations, we retrospectively examined the prognosis of patients with NSCLC who underwent GKS for synchronous brain metastasis and pulmonary resection.

    Methods
    We retrospectively reviewed the cases of patients with NSCLC and synchronous brain metastasis who underwent GKS preceding pulmonary resection from January 2006 to December 2012 at our institution. The eligibility criteria were thoracic stage I or II NSCLC, a performance status of 0­­­­­­­­­­­­­­–1, a predicted post-operative forced expiratory volume in 1 second of >600 ml/m[2], no extra-cranial metastasis, and brain metastatic lesions of < 3 cm.

    Results
    In total, 253 patients underwent pulmonary resection for NSCLC between January 2006 and December 2012. Six patients with NSCLC and synchronous brain metastasis underwent GKS preceding pulmonary resection, and received postoperative adjuvant systemic chemotherapy or molecular targeted therapy. All of them were Japanese, 4 were male and 2 were female. The mean age was 63 years (range, 47–78 years). Four patients had neurologic symptoms. The mean size of the primary lung lesion was 35 mm (range, 22–59 mm). The median number of brain metastases was 1 or 2 (range, 1–8) and the mean size was 16 mm (range, 7–28 mm). GKS was performed before pulmonary resection in all patients. The median time between GKS and thoracotomy was 2 weeks (range, 2–8weeks). Combined pulmonary resection was performed in 2 patients because of inter-lobar pleural invasion and lobectomy was performed in 4. Postoperative complications occurred in 1 patient: (thoracic empyema with bronchopleural fistula). Histologically, 4 patients had adenocarcinoma and 2 had large cell carcinoma. None of the patients showed evidence of lymph node metastasis after pulmonary resection (pN0). All patients received either platinum-taxol doublet therapy or molecular targeted therapy as postoperative adjuvant chemotherapy. One patient died 28 months after surgery because of new brain metastasis, and 5 were alive at 15, 18, 30, 66, and 88 months after pulmonary resection.

    Conclusion
    The pulmonary resection and GKS protocol resulted in long-term survival in 5 of 6 patients with synchronous brain metastasis from NSCLC. Although only a small number of cases were studied, this report may provide promising data with regard to a multidisciplinary therapeutic strategy for patients with newly diagnosed thoracic stage I or II NSCLC with brain metastasis. Further analysis and clinical studies are necessary to validate our findings.